Ariel I M
Cancer. 1982 Mar 15;49(6):1070-8. doi: 10.1002/1097-0142(19820315)49:6<1070::aid-cncr2820490603>3.0.co;2-q.
Of 3,305 patients with malignant melanoma seen at the Park Medical Group, New York, during the period from 1935-1975, there were 1,128 (34%) melanomas of the trunk. There were 646 melanomas of the skin of the chest wall (20% of all melanomas) and 482 melanomas of the abdominal wall (15%). Of 646 patients treated more than ten years ago, 138 were indeterminate as they were seen only in consultation or with evidence of blood-borne disseminated melanoma. Of the determinate 516 patients, 148 are free of evidence of melanoma after ten years, giving an absolute ten-year survival rate of 29%. All patients who died or who were lost to followup were considered to have died from the melanoma. Of 386 patients with melanoma of the thoracic wall, 296 were determinate, of which 88 (30%) have survived the ten-year period. Of the 260 patients with melanoma of the abdominal wall, 220 were determinate and 60 (27%) are alive and well ten years post treatment. Of 340 males, 74 survived the ten-year period (22%), much lower than the 32% ten-year survival of the 148 females. A preceding mole which existed in 254 patients resulted in a ten-year survival rate of 45%, much higher than the 116 patients whose moles arose de novo, of which 27% survived the ten year period. Of fifty patients with superficial melanomas, 34 (68%) survived ten years. The ten-year survival of 386 patients with infiltrating melanomas was 22%. The ten-year survival for patients in Stage I was 59%. Of 262 patients in Stage II, the ten-year survival rate decreased to 14% and for the 60 patients in Stage III, the ten-year survival rate was 7%. The situation was the same for melanomas of the chest wall as well as for the abdominal wall. Elective node dissection was performed in 122 patients with Stage I melanoma and in 42 (34%), microscopic evidence of melanoma was observed. The ten-year survival of patients with positive nodes was 38%. In 62 patients, no elective node dissection was performed and in 26 (42%), clinical evidence of metastases developed later. Of these, six (23%) survived the ten year period after a therapeutic lymph node dissection. We conclude that melanomas over 1 ml in depth (Breslow's classification), or Levels III, IV and V in Clark-Mihm's classification, elective regional lymph node dissection is warranted. Further studies are necessary to determine the exact treatment procedures for the superficial (Level II) melanomas. Level I melanomas should not be included in a report of metastasizing malignant melanoma.
1935年至1975年期间，在纽约帕克医疗集团就诊的3305例恶性黑色素瘤患者中，有1128例（34%）黑色素瘤发生于躯干。其中胸壁皮肤黑色素瘤646例（占所有黑色素瘤的20%），腹壁黑色素瘤482例（占15%）。在10多年前接受治疗的646例患者中，138例情况不明，因为他们只是前来咨询或有血行播散性黑色素瘤的证据。在明确诊断的516例患者中，148例在10年后无黑色素瘤迹象，绝对10年生存率为29%。所有死亡或失访的患者均被认为死于黑色素瘤。在386例胸壁黑色素瘤患者中，296例诊断明确，其中88例（30%）存活超过10年。在260例腹壁黑色素瘤患者中，220例诊断明确，60例（27%）在治疗后10年仍存活且状况良好。在340例男性患者中，74例（22%）存活超过10年，远低于148例女性患者32%的10年生存率。254例有既往痣的患者10年生存率为45%，远高于116例新发痣患者，后者10年生存率为27%。50例浅表黑色素瘤患者中，34例（68%）存活10年。386例浸润性黑色素瘤患者的10年生存率为22%。I期患者的10年生存率为59%。262例II期患者中，10年生存率降至14%，60例III期患者的10年生存率为7%。胸壁和腹壁黑色素瘤情况相同。122例I期黑色素瘤患者接受了选择性淋巴结清扫，其中42例（34%）发现有黑色素瘤的显微镜下证据。有阳性淋巴结患者的10年生存率为38%。62例患者未进行选择性淋巴结清扫，其中26例（42%）后来出现了转移的临床证据。在这些患者中，6例（23%）在进行治疗性淋巴结清扫后存活超过10年。我们得出结论，对于深度超过1ml（ Breslow分类）或Clark - Mihm分类中的III、IV和V级黑色素瘤，有必要进行选择性区域淋巴结清扫。需要进一步研究以确定浅表（II级）黑色素瘤的确切治疗方法。I级黑色素瘤不应纳入转移性恶性黑色素瘤的报告中。
